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Published on: August 1, 2017
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ICU delirium burden predicts functional neurologic outcomes
Luis Paixao1,2, Haoqi Sun1,2, Jacob Hogan1
1Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America.
Plos One
|December 2, 2021
Summary
Delirium burden throughout hospitalization significantly increases mortality risk and worsens long-term neurologic outcomes in mechanically ventilated patients. This burden is a stronger predictor than ICU-specific delirium or the number of delirium days.
Area of Science:
- Critical Care Medicine
- Neuroscience
- Patient Outcomes
Background:
- Delirium is a common complication in mechanically ventilated patients.
- The impact of delirium burden throughout hospitalization on long-term outcomes is not fully understood.
Purpose of the Study:
- To investigate the association between delirium burden (DB) during mechanical ventilation and functional neurologic outcomes up to 2.5 years post-discharge.
- To compare the predictive value of overall hospitalization DB versus ICU-specific DB.
Main Methods:
- Prospective cohort study of 178 mechanically ventilated adult patients.
- Daily delirium assessment using the Confusion Assessment Method for the ICU (CAM-ICU).
- Quantification of hospitalization delirium burden and assessment of survival and neurologic outcomes (Glasgow Outcome Scale) up to 2.5 years.
Main Results:
- Delirium burden was experienced by 77.4% of patients.
- Hospitalization delirium burden independently predicted increased mortality (>4-fold) and worse neurologic outcomes at multiple time points up to 12 months post-discharge.
- ICU-specific delirium burden and the number of delirium days were less predictive of mortality and neurologic outcomes compared to overall hospitalization DB.
Conclusions:
- Delirium burden throughout hospitalization is a significant independent predictor of long-term mortality and neurologic dysfunction after critical illness.
- Assessing delirium burden across the entire hospital stay provides greater predictive power than focusing solely on the ICU period.
- These findings highlight the importance of managing delirium throughout the patient's entire hospital course to improve long-term recovery.
